Provider Demographics
NPI:1982627956
Name:REID, TARA (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 N LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2507
Mailing Address - Country:US
Mailing Address - Phone:562-498-8000
Mailing Address - Fax:562-494-8880
Practice Address - Street 1:2255 N LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2507
Practice Address - Country:US
Practice Address - Phone:562-498-8000
Practice Address - Fax:562-494-8880
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6919207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972792729OtherMEDICARE GROUP NPI
CA00AX69190Medicaid
CA1982627956OtherMEDICARE INDIVIDUAL NPI
CAGR0105170Medicaid
CA1982627956OtherMEDICARE INDIVIDUAL NPI
CAG83471Medicare UPIN